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A.-L. Saare1,2,3, I. Müürsepp4
1Bern University of Applied Sciences, Bern, Switzerland, 2Haapsalu Neurological Rehabilitation Centre, Haapsalu, Estonia, 3University Hospital Berne, Berne, Switzerland, 4Clinic, Oromyofunction, Tartu, Estonia
Background: Selective dorsal rhizotomy (SDR) is an operation performed on patients with the spastic bilateral type of cerebral palsy (CP). The operation is considered to be the only permanent method to reduce spasticity, improve gait parameters and avoid various secondary health issues. However, literature on SDR outcomes is conflicting.
Purpose: The goal of this study was to analyse gait parameters in children prior to and one year after SDR, compare the outcomes to existing scientific literature and determine whether the received intervention or age affected the outcomes.
Methods: A retrospective study was conducted among eight children (mean age 11.25 years, range 5 – 17). The children had bilateral spastic CP and underwent a gait analysis prior to and one year after SDR. Data was collected with Vicon motion and gait analysis systems (8 MX T-Series infrared cameras, 2 video cameras and 2 AMTI force plates; all solutions were supported by Vicon software: Vicon Nexus and Vicon Polygon). For the analysis, various comparable tables were compiled in Excel, Pearson correlation was used to determine statistical significance and scatter plots to assess relationships between variables. All SDR operations on children with CP were performed by the same surgeon using the single-level method.
Results: The direction of the relationship between age and dorsal flexion of the ankle was negative (rp=-0.820). The Pearson analysis indicated a statistically significant correlation at a 95% confidence interval (p=0.013). According to the scatter plots, age had a negative relationship with dorsal flexion of the right ankle, knee extension during stance phase and flexion of the left knee during the swing phase. The mean change in gait speed was 0.14 m/s. The amount of physiotherapy received had a positive correlation with hip flexion during stance.
Conclusion(s): Younger patients had better outcomes. The amount of received physiotherapy had small to no positive influence on the improvement of gait. Due to a small sample size, results should be interpreted with caution. The effect of SDR on gait kinematics and the influence of physiotherapy needs further Research.
Implications: The amount of physiotherapy does not play a significant role in the improvement of gait kinematics after SDR operation. Further research should evaluate which physiotherapy intervention improves gait most efficiently.
Funding, acknowledgements: This work was unfunded.
Keywords: selective dorsal rhizotomy, 3D Gait Analysis, cerebral palsy
Topic: Paediatrics: cerebral palsy
Did this work require ethics approval? Yes
Institution: Tallinn National Institute for Health Development
Committee: Tallinn National Institute for Health Development
Ethics number: 2431
All authors, affiliations and abstracts have been published as submitted.
